Respiratory syncytial virus (RSV) is a leading cause of severe lower respiratory tract disease, especially in young children. Despite its global impact on healthcare, related to its high prevalence and its association with significant morbidity, the current therapy is still mostly supportive. Moreover, while more than 50 years have passed since the first trial of an RSV vaccine (which unfortunately caused enhanced RSV disease), no vaccine has been approved for RSV prevention. In the last two decades, our understanding of the pathogenesis and immunopathology of RSV have continued to evolve, leading to significant advancements in RSV prevention strategies. These include both the development of new potential vaccines and the successful implementation of passive immunization, which, together, will provide coverage from infancy to old age. In this review, we provide an update of the current treatment options for acute disease (RSV-specific and -non-specific) and different therapeutic approaches focusing on RSV prevention.

Background: Acute asthma exacerbations are a common cause for emergency department (ED) visits and hospitalizations in children. Since the outbreak of coronavirus disease 2019 (COVID‐19) and the education system closure/total lockdown in Israel on March 2020, we have noticed a decrease in pediatric ED visits and an increase in hospitalizations of asthma exacerbations.Objective: to examine the patterns of ED visits for asthma exacerbations during COVID‐19 outbreak, in comparison to the previous year.Methods: A retrospective study comparing asthma related ED visits and hospitalizations among children aged 2–18 years at a tertiary center in southern Israel. Three time periods were selected: 2020 A (prelockdown, 2/1/20 to 3/14/20), 2020 B (lockdown, 3/15/20 to 5/15/20) and 2020 C (postlockdown, 5/16/20 to 6/30/20) and compared to the three parallel time periods in 2019. Data regarding demographics, number of ED visits and clinical severity parameters were collected and analyzed.Results: Five hundred and twelve children visited the ED for asthma exacerbation: 273 children during 2019 and 239 children during 2020. Lockdown period in 2020 revealed significantly fewer ED visits per day compared to the parallel calendar period in 2019 (1.8 vs. 1.43, p < .001). Significantly higher hospitalization rate (47.1% vs. 33.7%, p = .05) and longer length of stay (3.15 vs. 1.9 days, p = .03) were observed during the lockdown.Conclusion: Lockdown is associated with fewer ED visits for asthma exacerbation, probably due to; reduced exposure to viral infections and environmental allergens, decreased availability of primary physicians and families' reluctance to arrive to the ED. ED visits during lockdown were characterized by higher hospitalization rate and longer LOS.

Rationale: The typical symptoms of primary ciliary dyskinesia (PCD) manifest after birth and in early infancy, but diagnosis is often not confirmed during infancy. There is currently a lack of evidence in PCD regarding the impact of the age of the patient at the time of diagnosis on clinical outcomes. Objective: To determine whether early diagnosis of PCD is related to improved long-term outcomes. Methods: This was a retrospective study of patients diagnosed with PCD between 2000 and 2022. We divided our cohort into three groups according to the age at diagnosis: (1) early diagnosis (age <1 year), typical diagnosis (age 1–7 years), and late diagnosis (age 8–14 years). We compared various clinical long-term outcomes between the groups. Results: During the study period, 110 patients were included in the analysis, with 41 patients in the early diagnosis group, 35 in the typical diagnosis group, and 34 in the late diagnosis group. Unexplained neonatal respiratory distress and organ laterality defect were more common in the early diagnosis group, with respective rates in the early, typical, and late diagnosis groups of 80%, 53%, and 61% for neonatal respiratory distress (P = 0.045) and 64%, 50%, and 18% for laterality defect (P < 0.001). At the end of the first decade of life, patients in the early and typical-age diagnosis groups had better forced expiratory volume in 1 second compared with the late diagnosis group (93.5% and 93.1% vs. 80.2%; P = 0.002), but there was no significant change in the annual rate of decline between the groups when diagnosis had been confirmed. Patients diagnosed late had significantly higher rates of pulmonary exacerbations than those diagnosed at a typical age (1.95 vs. 0.75 per year; P < 0.01) Conclusions: Late diagnosis (age ≥8 years) was associated with lower forced expiratory volume in 1 second throughout childhood, although, once diagnosed, the annual rate of decline was not different. These findings demonstrate the negative effect of delayed diagnosis in pediatric PCD.

Rationale: Chronic infection with Pseudomonas aeruginosa (PsA) negatively impacts lung disease in patients with primary ciliary dyskinesia (PCD). There is currently limited evidence regarding the efficacy of PsA antibiotic eradication therapy (AET) in children with PCD. Objectives: To assess the effectiveness of AET of early PsA infection in children with PCD. Methods: This retrospective study included pediatric patients with a confirmed PCD diagnosis according to the American Thoracic Society guidelines at the Hospital for Sick Children between 2010 and 2022. Children with newly acquired PsA infection underwent AET using a stepwise protocol. The protocol included the following steps: step 1, 28 days of tobramycin inhalation solution (TIS); step 2, repeat TIS if culture positive after step 1; and step 3, 14 days of intravenous antibiotics followed by 28 days of TIS if culture positive after step 2. Step 3 was also used for patients who presented with pulmonary exacerbation symptoms. The main outcome was a PsA-negative culture result based on the microbiological results of the first culture after completion of each step of treatment. Results: During the study period, 31 children had a new PsA infection and underwent AET. Of the 27 children who had been asymptomatic at the time of the PsA infection, negative PsA culture results were achieved in 20 (74%) of 27, 1 (14%) of 7, and 5 (83%) of 6 after steps 1, 2, and 3 of AET, respectively. All four symptomatic patients who initially were treated with step 3 had successful clearance of PsA. The overall cumulative success rate of the protocol for negative culture results after AET was 97% (30 of 31). For patients in whom AET was successful, the probability of staying PsA free for at least 1 year was 70%. Conclusions: AET for early PsA infection is highly effective in PCD, with sustained efficacy in most individuals. These data suggest that AET should be considered in all children with PCD who have early PsA infection.